Credentialing & Contracting Forms

For Clinicians: 

• Provider Participation Request, which details provider information needed by Select Health to begin the credentialing process. There is also a shorter version designed for expansion markets.
• Credentialing forms for physicians and advance practice providers without a Council for Affordable Quality Healthcare (CAQH) profile.

For Facilities and Vendors:

• Select Health Panel Request form for initiating a credentialing/contracting request by a facility of vendor.
• Facility/Vendor Credentialing Request form, which details provider information needed by Select Health to complete the credentialing process.